What is a Hematoma?
A hematoma is a collection of blood outside of a blood vessel. It occurs because of an injury to a blood vessel, allowing blood to seep out into surrounding tissues where it does not belong. Hematomas can occur anywhere in the body. Common locations include under the skin, in muscle tissue, and inside organs or joints.
Causes of Hematomas
Some common causes of hematomas include:
- Trauma – Getting hit or falling can damage blood vessels and cause localized bleeding.
- Surgery – Surgical procedures can accidentally nick blood vessels, allowing blood to collect.
- Anticoagulants – Medications that thin the blood increase bleeding risk and make hematomas more likely.
- Blood disorders – Conditions like hemophilia impair blood clotting, increasing susceptibility to hematomas.
Hematomas can form gradually over hours or days as blood slowly seeps from damaged vessels, or they can develop rapidly after an injury. Smaller hematomas may heal on their own as the blood is slowly reabsorbed. Larger hematomas generally require medical treatment.
Diagnosing a Hematoma
Doctors use a combination of inspection, palpation, and imaging to diagnose hematomas:
- Inspection – Visual examination of the skin often reveals swelling and bruising over a hematoma.
- Palpation – Carefully feeling the area allows doctors to detect tender, fluid-filled masses.
- Imaging – CT scans, MRIs, and ultrasounds provide detailed views of hematomas inside the body.
Doctors also consider the person’s medical history and risk factors like use of blood thinners. Pain, limited range of motion, and numbness can also indicate a hematoma is pressing on nerves.
Types of Hematomas
- Subcutaneous – Bleeding directly under the skin. Causes bruising.
- Intramuscular – Bleeding within muscle tissue. Can compress nerves.
- Retroperitoneal – Bleeding behind the abdominal lining. Can be life-threatening.
- Subungal – Bleeding under a fingernail or toenail.
- Intracranial – Bleeding between the skull and brain. Most dangerous type.
Treating Hematomas
The appropriate treatment for a hematoma depends on its location and size:
Small Hematomas
Small subcutaneous hematomas often heal well without intervention. Doctors recommend RICE therapy:
- Rest
- Ice
- Compression
- Elevation
This helps minimize swelling and speed reabsorption of the blood. Over-the-counter pain medication like acetaminophen or ibuprofen can provide relief.
Large Hematomas
Larger hematomas may require drainage and surgery. This helps:
- Relieve pressure on surrounding tissues
- Reduce pain and swelling
- Speed healing
- Prevent infection
Doctors may drain hematomas through needle aspiration or by making a small incision in the skin. After draining the blood, they take steps to stop further bleeding and help the remaining blood clot.
Recovering from Hematoma Surgery
After hematoma drainage, recovery steps include:
- Bandaging the area
- Keeping the area elevated
- Using crutches to avoid putting weight on the area
- Taking prescribed antibiotics and pain medication
- Going to follow-up appointments so doctors can monitor healing
Activity should be restricted until healing is well underway. Physical therapy often helps restore full mobility. Most hematomas resolve without complications, but some risk factors include:
- Infection
- Delayed healing
- Re-accumulation of blood
- Compartment syndrome
- Permanent nerve damage
Seeking prompt medical treatment helps minimize these risks.
Surgical Removal Procedures
If a hematoma is in a dangerous location or compressing vital structures, surgeons may perform an open surgical procedure to remove it and stop the bleeding. Common techniques include:
Hematoma Evacuation
- The skin is cut open to expose the hematoma.
- The blood is drained out through the incision.
- Bleeding blood vessels are identified and tied off.
- A drain may be left in place temporarily.
- The incision is closed with sutures.
Hematoma Removal
- The hematoma is located and dissected out.
- Associated tissue damage is repaired.
- Bleeding vessels are clamped and ligated.
- Dissected areas are irrigated and suctioned.
- Drains and sutures close the site.
More extensive procedures may be required depending on the hematoma’s size and location.
| Type of Hematoma | Removal Techniques |
|---|---|
| Epidural | Hematoma evacuation via burr holes or craniotomy |
| Subdural | Hematoma evacuation via craniotomy or craniectomy |
| Retroperitoneal | Open abdominal surgery for hematoma removal and vessel repair |
| Muscular | Incision over the muscle for hematoma drainage |
Proper follow-up care after surgery helps ensure the hematoma does not reaccumulate once the bleeding is stopped.
Minimally Invasive Drainage Techniques
For some accessible hematomas, doctors can use minimally invasive techniques to drain the blood rather than open surgery:
Needle Aspiration
- A needle is inserted directly into the hematoma.
- Ultrasound guidance may be used.
- The blood is drained through the needle.
- Pressure is applied to help the remaining blood clot.
Catheter Drainage
- A flexible catheter tube is inserted into the hematoma.
- The blood drains out through the catheter.
- The catheter may be left in place for several days.
- This technique can slowly drain large hematomas.
These methods allow drainage without large incisions. However, open surgery may still be required if bleeding persists.
Recovery Process and Expectations
Recovering from hematoma removal depends on the location, surgical method, and your overall health. Here is what to expect:
Pain
- There will be pain, swelling and bruising around the hematoma site.
- Your doctor will prescribe pain medications to help manage discomfort.
- Ice packs may provide additional relief.
- Pain should gradually improve over days to weeks.
Activity
- Avoid using or putting weight on the affected area as it heals.
- Follow activity restrictions provided by your doctor.
- Gradually increase activity and exercise as the area heals.
- Physical therapy often helps regain flexibility and strength.
Wound Care
- Keep drainage tubes and bandages clean and dry.
- Change dressings as directed.
- Watch for signs of infection like fever or increased swelling/discharge.
- Stitches or staples will need removal.
Follow-Up Appointments
- See your doctor as scheduled to monitor healing.
- Imaging tests may be ordered to check hematoma size.
- Medications or physical therapy may be adjusted.
- Most hematomas resolve within a few weeks with proper treatment.
Call your doctor immediately if you have any concerns like high fever, severe pain, or excessive bleeding. With appropriate rest and care, most people recover fully within 4-6 weeks after hematoma removal.
Preventing Hematomas
While some hematomas arise spontaneously, you can take steps to lower your risk:
- Treat underlying conditions like hemophilia or anticoagulant use.
- Wear protective gear for contact sports.
- Strengthen muscles through exercise to prevent falls.
- Take medications exactly as prescribed.
- Have regular physical exams to detect vessel problems early.
Getting prompt treatment for injuries that damage blood vessels can also keep small bleeds from turning into serious hematomas. Seek medical attention after any significant trauma or bruising episodes.
Conclusion
Hematomas form when blood vessels are damaged and leak blood into tissues where it does not belong. Small hematomas may heal on their own, but larger ones generally require drainage procedures to remove the blood and stop bleeding. This relieves pressure, reduces swelling, speeds recovery, and lowers infection risk. Hematoma removal techniques range from minimally invasive needle aspiration to open surgery depending on the size and location. Following doctor’s orders during the recovery period is crucial. Most hematomas can be dealt with effectively if proper treatment is obtained quickly after they occur. While some risk factors are unavoidable, taking sensible precautions can help reduce your chances of developing a dangerous hematoma.